Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

05. Andro (1569) > Andrology > Flashcards

Andrology Flashcards

1
Q

What determines penile erection?

A

The tone of penile smooth muscle

relaxation –> erection
contraction –> flaccidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the patophysiology for the penile erection?

A

Nerve stimulation (Norepinephrine is released)—>
Nitric oxide (NO) is released –>
which transformes
Guanylate cyclase (GTP)–> to cyclic guanylate cyclase (cGMP)
this lowers the intracellular concentration of Ca2+ –>
relaxation of smooth muscle and increased blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the patophysiology for PDE-5 inhibitors?

A

PDE-5 is an enzyme that breaks down cGMP which leads to a contraction of smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the prevalence of ED (erectile dysfunction) for men aged 40-70?

A

52%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the prevalence of complete ED (erectile dysfunction) for men aged 40-70?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are risk factors for ED (erectile dysfunction)?

A 
age
dyslipidemia
hypertention
diabetes
smoking
sedetary lifestyle
obesity
depression
CAD, peripheral vascular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can erectile dysfunction predict?

A

Coronary events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can you improve ED without medication?

A

Lifestyle changes (regular exercise and decrease in body mass index)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the basic investigation that should be conducted for ED (erectile dysfunction)?

A

Complete medical and sexual history
Use validated questionnaire
Physical examination
Routine laboratory tests (including glucose-lipid profile, testosterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the indications for specialised investigation of ED?

A 
Primary ED (lifelong)
Perineal or pelvic trauma
Anatomical penile deformities
Psychiatric disorder/ psychological problem
Complex endocrine disorder
Patiens request
Medicological reasons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Specific diagnostic tests for patients with ED:

A 
Rigiscan (NTPR)
Vascular studies
- colour doppler scanning
- Cavernosography
Neurological studies
Endocrinological studies
Specialised psychodiagnostic evalutation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What share of obese men can get an improvement in sexual function from lifestyle changes?

A

One third

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What PDE5-inhibitor can be used daily for spontaneous sexual activities?

A

Tadalafil 5 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the role of Low-intensity extracorporeal shock wave therapy in the treatment of ED?

A

There is limitied data but positive short-term clinical and physiological effects
Preliminary data shows improvement in penile haemodynamics and endothelial function in severe ED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the side-effects of topical Alprostadil?

A

penile erythema

penile burning and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the success rate of intracavernous injection of Alprostadil on ED?

A

85%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the side-effects of intracavernous injection of Alprostadil?

A

Pain
Dizziness
Priapism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the first line of treatment for ED?

A

PDE5-inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the second line of treatment for ED?

A

Intracavernous injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the third line of treatment for ED?

A

Penile prosthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What penile curvature is most common?

A

Ventral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What surgical techniques can be used on penile curvatures?

A

Plication
Nesbit (boatformed excision of the tunica albuginea)
Grafting
Penile Prosthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When should a penile curvature be corrected?

A

After puberty, otherwise any time in adult life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the pathophysiology of Peyronie’s disease?

A

Fibrotic lesions or plaques are formed in the tunica albuginea
This happens in two phases:
- Acute inflammatory phase (can be painful)
- disease stabilisation/formation of plaques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In Peyronie’s disease what clinical factors should be evaluated?

A 
duration of disease
penile pain
change of deformity
dificulty in vaginal intromission
erectile dysfunction (ED)

assessment of palpatable plaques
penile length
extent of curvature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What treatment for Peyronie’s disease should NOT be used?

A

Oral treatment with vitamin E and tamoxifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When can surgical treatment for Peyronie’s disease be considered?

A

After 3 months of stable disease

and when intercourse is compromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When can plication techniques be used on Peyronie’s disease?

A

Adequate penile lenght
curvature <60°
no hour-glass deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the difference between physiological erection and priapism?

A

It is limited to the cavernous bodies, not affecting the corpus spongiosum or the glans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What type of priapisms are there?

A 
Low flow (acute)
High flow (not acute)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What can you find in Low flow priapism but not usually in High flow priapism?

A

Corpora cavernosa fully rigid
Penile pain
Abnormal cavernosus blood gases

Sometimes:
Blood abnormalities/hmatologic malignancy
Recent cavernosus vasoactive drug injections

Seldom (but usually present in High flow priapism):
Chronic, well tolerated tumescence without full rigidity

Perineal trauma (sometimes with High flow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Describe Low flow priapism:

A

veno-occlusive

more frequent
greater potential of permanent alteration of erectile function

partial or complete obstruction of corpora caveronsas drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe High flow priapism:

A

arterial

  • the cavernosus artery, or one of its branches, is lacerated, forming an arterio-lacunar fistula
  • in the area adjacent to the fistula tubulent blood flow creates mechanical forces on the endothelial which promotes NO production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the most common cause of priapism in childhood?

A

Sickle cell anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

In patients with priapism what labaratory tests should be performed?

A

complete blood count
white blood count with blood cell differential
platelet count
coagulation profile

+ blood gas from penile blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What exam can help differentiatie between ischemic priapism and non-ischemic priapism if the blood gas is inclonclusive?

A

colour duplex ultrasound of the penis and perineum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

In case of prolonged ischaemic priapism what imaging can be done to predict smooth muscle viability and confirm erectile function restoration?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What should be performed before embolisation of non-ischemic priapism?

A

selected pudendal arteriogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are are the diagnostic findings of Ischemic priapism?

A

Painful, rigid erection
Blood gas: Dark blood, hypoxia, hypercapnia and acidosis
US: sluggish or non-existent blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are are the diagnostic findings of non-ischemic priapism?

A

Perineal or penile trauma, painless, fluctuating erection
Blood gas: Bright red blood, arterial blood gas values
US: normal arterial blood flow, may be turbulent at site of a fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Treatment of ischemic priapism (4 steps):

A
  1. Local anastesia of the penis
    Insert needle (butterfly) 16-18 G through the glans penis into the corpora cavernosa
    Aspirate until bright arterial blood
  2. Cavernosal irrigation: irrigate with saline solution

3.
Inject intercavernosal adrenoceptor agonist
(Phenylephrine 200µg every 3-5 min max 1 mg within an hour)

4.
Surgery:
Shunting or
Consider primary penile implantation if priapism >36H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Describe 3 cavernoglanular or coporoglanular shunts:

A

Winter technique: large biopsy needle inserted through the glans

Ebbehoj technique: scalpel inserted percutaneously through the glans

Al-Ghorab shunt: excising a piece of the tunica albuginea at the tip of the corpus cavernosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

In proximal shunts igive 2 examples of vessels that the corpora cavernosa can be grafted to:

A

Spongiosum

Saphenous vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the benefits of early insertion of penile prosthesis as a treatment for priapism?

A

Maintains penile lenght
Easy insertion
Treats the condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the the drawbacks of late insertion of penile prosthesis after priapism?

A

Penile shortening

Difficult implantation

46
Q

How should your treat priapism due to sickle cell anemia?

A 
The same way as "ordinary" priapism
and
other supportive measures:
intravenous hydration
oxygen administation
alcalisation with bicarbonates
blood exchange transfusions
47
Q

How should non-ischemic priapism be treated?

A

Superselective arterial embolisation, using temporary material

48
Q

In how many couples is it male factors that cause infertility?

A

30%

40% contribuary

49
Q

How is infertility defined?

A

Failure to conceive after regular, unprotected intercourse for at least 12 months

50
Q

How many couples are affected by infertility?

A

15%

51
Q

How often is Azoospermia found in infertile men?

A

15-20%

52
Q

What is the difference between primary and secondary infertility?

A

Primary: failure to achieve first pregnancy
Secondary:failure to achieve second pregnancy

53
Q

What are the most common causes of male infertility (8/%)?

A 
Unexplained 34%
Varicocele 17%
Hypogonadism 10%
Urogenital infections 9%
Undescended testes 8%
Sexual factors 6%
Immune system factors 5%
Systematic disease 3%

Testicular dysgenesis syndrome TDS: environmental causes

54
Q

What hormonal system regulates testosteron?

A

The HPG-axis

Hypothalamus: GnRH
-->
Pituitary (hypofys): LH + FSH
--->
Testes: testosterone
55
Q

What does the basic investigation of the infertile man include?

A

Semen analysis
Hormone measurement
Imaging
Testis biopsy

56
Q

What hormones should be assesed in an infertile man?

A 
LH
FSH
Prolactin
Testosteron
SHBG
57
Q

How should semen samples be collected?

A

Abstinence 2-5 days
Collection without spericides
Transport within an hour
At least 2 samples a month apart

58
Q

What is a normal semen sample?

A 
Volume 1,4-1,7 mL
Total sperm number 33-46 million
Sperm concentration 12-16 million/mL
Total motility 38-42
Progressive motility 31-34%
Vitality (live speratozoa) 55-63%
Sperm mofphology 3,0-4,0%
59
Q

Aspermia

A

The patient produces no semen

60
Q

Azoospermia

A

The patient produces semen that does not contain sperm

61
Q

Oligozoospermia

A

low sperm concentration < 15 million /mL

62
Q

Asthenozoospermia

A

Reduction in motility

63
Q

Teratozoospermia

A

abnormally shaped sperm

64
Q

Necrospermia

A

all sperm are dead

65
Q

Pyospermia/Leucospermia

A

presence of large number of white blood cells in teh semen, often associated with an infection

66
Q

What glands contributes to semen volume?

A

Seminal vesicles 2,0 mL
Prostate 0,5 mL
Cowpers glands 0,1 mL

67
Q

What is a normal pH for the ejaculate?

A

7,9-8,1

68
Q

Infections that cause male infertility through orchitis:

A 
Mumps
Brucellosis
Typhoid
Influenza
Syphilis
69
Q

Infections that cause male infertility through obstruction:

A 
Tuberculosis
Gonorrhoea
Chlamydia
Filariasis
Smallpox
70
Q

What is SHBG and what role does it play in the blood?

A

SHBG= sex hormone binding globulin

Binds 60% of testosteron in the blood
48% is loosely bound to albumin
2 % is free

71
Q

Factors that decrease SHBG:

A

–> resulting in more bioavailable testosteron
Obesity
Diabetes
Hypothyroidism
Nephrotic syndrome
Use of glucocorticoids, progestins and androgenic

72
Q

Factors that increase SHBG:

A 
--> resulting in less bioavailable testosteron
aging
hepatic cirrhosis
hyperthyroidism
HIV infection
Estrogens
73
Q

Oestrogen antagonists- mechanism of action:

A

indirect stimulation of FSH and LH by blocking oestrogen receptors in the hypothalamus and pituatary
–> increase in GNRH

The effect is a stimulation of Leydig cells to produce testosteron and Sertolicells to augment testicular environment for spermatogenes

74
Q

What is the role of Sertoli cells?

A

They make a favourable environment for the spermatogenesis

75
Q

What is the role of Leydig cells?

A

They produce Testosteron

76
Q

Aromatase inhibitors -mechanism of action:

A

They decrease the conversion of androgens to estrogens by feedback inhibition of pituitary/hypothalamus resulting in release of GNRH
–> increase in androgens

77
Q

How do you treat men with hypogonadotropic hypogonadism?

A

coctail of:
hCG
hMG (human menopausal gonadotropins)
recombinant FSH

78
Q

What is hypogonadotropic hypogonadism?

A

or secondary hypogonadism

absent or inadequate hyupothalamic GnRH-secretion
or
abnormal pituitary gonadotropin levels (LH and FSH)
–>
gonadal failure

79
Q

Should patients with primary and secondary hypogonadism get testosteron replacement therapy?

A

Yes IF
they have symptoms and
do not wish parenthood

80
Q

What is the incidence of chromosomal anomalies in the general population?

A

0,4-0,6%

81
Q

What is the Human Azoospermia Factor?

A

AZF-gene
on Y chromosome
11q position

Deletions –> Azoospermia /Oligospermia

82
Q

How is cystic fibrosis linked to infertility?

A

It can cause vasal aplasia

83
Q

How common is cystic fibrosis?

A

1/600

84
Q

What is important to inform patients about before intracytoplasmic sperm injections (ICSI) is performed if the patient has a Yq microdeletions?

A

The microdeletion will be passed on to sons but not to daughters

85
Q

If the patients has a structural abnormality of the vas deferens, what should be done?

A

Testing for cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations

86
Q

When do you do a TRUS in an infertility investigation?

A

Low volume ejaculation (exclude retrograde)
Acidic pH
Palpable vasa
Normal hormonal profile

87
Q

Grad I Varicocele:

A

Palpable only with vasalva

88
Q

Grade II Varicocele:

A

Palpable in standing position

89
Q

Grade III Varicocele:

A

Visible through the scrotal skin and palpable when the patient is supine

90
Q

Grade IV Varicocele:

A

Only US-diagnosis

reflux while performing valsalva

91
Q

Grade V Varicocele:

A

Only US-diagnosis

reflux always

92
Q

Pathophysiology of Varicocele induced changes in the testis:

A

Hyperthermia
Raised venous pressure- reduced arterial flow
Hormonal imbalance- reduced testosteron- reduced Leydig cell function
Toxic substances - catecholamines
Teactive oxygen species

–> Sperm DNA fragmentation

93
Q

What are the three ligation techniques for Varicoceele

A

Subinguinal
High inguinal
Retroperitoneal

94
Q

When should treatment for a varicocele be considered?

A

clinical varicocele, oligospermia, duration of infertility of at least 2 years and otherwhise unexplained infertility in the couple

95
Q

What are the reconstructive options for obstruction of vas?

A

Vasovasostomy
Vasoepididymostomy
Transurethral incision of ejaculatory duct

96
Q

Pregnancy rate of vasoepididymostomy:

A

18-30%

97
Q

What is the pregnancy rate after microsurgical reconstructional vasovasostomy after vasectomy?

A

76% if 3 years or less

30% if 15 years or more

98
Q

What are the indications for sperm retrieval?

A

Non obstructive Azoospermia

Obstructive Azoospermia:
vasal aplasia
vasal obstruction
Intratesticular obstruction
Ejaculatory duct obstruction
Epididymal obstruction
99
Q

How do you avoid recanalisation after a vasectomy?

A

Cauterisation and

fascial interposition

100
Q

What are the complications of a vasectomy?

A

Infection 0,5-1,5%
Bleeding/haematoma 4-22%
Re-canalisation 1:2000
Chronic orchalgia 1-14%

101
Q

What are the most common forms om primary hypogonadisms?

A 
Maldescended or ectopic testes
Testicular cancer
Orchitis
Acquired anorchia
Secondary testicular dysfunction
(idiopathic) testicular atrophy
Congenital anorchia
Klinefelters syndrome
46 XY disorders of sexual development (DSD)
Gonadal dysgenesis
46 XX male syndrome
Noonan syndrome
Inactivating LH receptor mutations, Leydig cell hypoplasia
102
Q

Most common forms of secondary hypogonadism

A

Hyperprolactinemia (adenom, drug-induced)
Isolated hypogonadotrophic hypogonadism (mutations affecting GnRH synthesis or action)
Kallmann syndrome (1: 10 000)
Secondary GnRH deficiency (medication, drugs, toxins,systemic diseases)
Hypopituitarism
Pituitary adenomas
Prader-Willi syndrome (1: 10 000)
Congenital adrenal hypoplasia with hypogonadothrophic hypogonadism (1: 12 500 X-chromosomal recessive disease)
Pasqualini syndrome (isolated LH deficiency)

103
Q

What is primary hypogonadism?

A

Problem is on Testicular level, no testosteron is produced

104
Q

What is secondary hypogonadism?

A

Problem is on a hypothalamic or pituitary level, no stimulation with GnRH, LH or FSH –> no testosteron

105
Q

What are the effects of testosterone deficiency?

A 
Fatigue
Depression
Increased risk of alzheimers
Increased fat tissue
Increased risk of ED &amp; low libido
Increased risk of osteoporosis
106
Q

When should you measure testosteron?

A

In the morning before 11.00 preferably in the fasting state

107
Q

Clinical signs of androgen deficiency (12):

A 
Reduced testis volume
Male-factor infertility
Decreased body hair
Gynaecomastia
Decrease in lean body mass and muscular strength
Visceral obesity
Metabolic  syndrome
Insulin resistance and type 2 diabetes
Osteoporosis, low trauma fractures
Mild anemia
Sexual symptoms (less desire/activity, ED, less nocturnal erections)
Cognitive and psychovegetative syptoms (hot flushes, moodchanges, fatigue, sleep disturbances, depression, diminished cognitive function)
108
Q

Criteria for the definition of the Metabolic syndomre:

A

3 of 5

Waist circumference > 94-102 cm
Triglycerides > 150 mg/dl (or treatment)
HDL-Cholesterol < 40 mg/dl (or treatment)
Arterial Blood Pressure >130 systolic and/or 85 diastolic (or treatment)
Fasting glucose > 100 mg/dl (or type 2 diabetes)

109
Q

What is the single most powerful predictor of secondary hypogonadism in ageing men in the general population?

A

Obesity

110
Q

What factors should be considered when measuring testosteron?

A

Two measurements of total testosteron (before 11:00 in the morning)
If the level is close to normal range or suspected/known abnormal SHBG-lewels

111
Q

What are the contraindications for Testosteron treatment?

A 
Locally advanced or metastatic prostate cancer
Male breast cancer
Men with active desire to have children
Haematocrit >0,54
Severe chronic cardiac failure /NYHA IV
112
Q

What labratory tests should be monitored during testosteron treatment?

A

Testosterone
Haematocrit
Haemoglobin
PSA

at three, six and twelve month, then anually

05. Andro (1569) (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions